unspoken forces at work

 

Hippocrates is the one who advised physicians, "First, do no harm." Cicero proclaimed, "The safety of the people shall be the highest law"...lofty principles that, to this day, both challenge and inspire health care professionals.

It was Paraclesus, though, who declared, "The physician should speak of what is invisible...He becomes a physician only when he knows that which is unnamed, invisible, and immaterial, yet has its effects." He was speaking, of course, about the impact of the patient's thoughts, feelings, and emotions on his experience of injury and illness. These include his fears, expectations, and hopes...all invisible, all immaterial. 

"O, what an untold world

 there is in one human heart."

~Harriet Beecher Stowe~

In his book, "The Wise Heart," Jack Kornfield reminds us that the key to healing has to do with the patient's understanding of his illness. What is he fearful about? Why? What does he think will happen to him? How will he support his family? Who will take care of her children? It turns out making the diagnosis is sometimes the easy part. Uncovering the patient's hidden fears can be harder.

"You'd be surprised

what lengths people will go to

not to face what is real and painful 

inside them."

~Ian Kester~

For example, let's say a patient presents with breast cancer. She is forty-four years old, the same age her mother was when she was diagnosed. But her mother died following surgery and a full course of radiation and chemotherapy. This is what scares her. She jumps to the conclusion that this is her fate as well, despite the fact that her mother's cancer was far more advanced when it was detected. Despite the fact that treatment has improved in the twenty years since her mother's diagnosis. The patient's initial reaction to her diagnosis may be to give up right then and there...her unnamed, invisible, and immaterial thoughts, feelings, and emotions left unchecked.

"Your body hears everything

your minds says."

~Naomi Judd~

Or, let's say the patient is a middle-aged man who schedules a ten minute appointment with you so he can get something for his heartburn. But he isn't simply experiencing indigestion. He is having angina, and it's getting worse. He has convinced himself that it's just his stomach because the thought of a heart attack scares him. His brother had one last year, and ended up with a pacemaker and a defibrillator. His ten minute appointment includes an EKG and blood work, and it stretches into a forty-five minute dialogue about unstable angina and the need for hospitalization. He tries to laugh it off, but beneath his cavalier manner, he fears for his life. His family. His business. All of it unspoken, invisible, immaterial.

"A physician is obligated to consider

more than a diseased organ,

more than even the whole man.

He must view the man in his world."

~Harvey Cushing~

Clues to the unspoken forces at work in the patient's life include refusal of, or noncompliance with treatment. Denial, anger, impatience, or resistance. Reticence. Despair. 

The health care provider should handle these patients with care. Ask about their fears, expectations, and perceptions. Take time to speak about what you intuit to be unnamed, invisible, and immaterial. 

"Anything will give up its secrets

if you love it enough."

~George Washington Carver~

jan

the moose in the mud

 

"The clearest way into the universe is through a forest path." 

~John Muir~

I was lucky enough to have been invited to spend last week in a cabin in the Maine woods. My "bucket list" item for the trip was to spot a moose, and I did. But not in the way I had hoped.

My daughter and I set out one evening for a bog that was known by the locals as a good place to watch for moose. We pulled off the road and waited...and waited...and waited. We thought we were seeing a bird flapping its wings every so often, until we realized we were seeing the ears and tail of a moose twitching as she lay in the mud. 

We pulled up closer, and sure enough...there she was, lying in the mud, barely visible. It occurred to us that she might be sick or injured, but she wasn't struggling, or calling out. So we concluded that, like all good mamas, she just needed a little time to herself, and what better place for a moose on a hot day than in a nice cool mud bath. Still, we didn't think it was too much to ask for her to stand up and take a few steps for us, so we whistled at her, clapped our hands, called out to her, and honked at her. We pleaded with her and cajoled her...all to no avail. We gave up as darkness closed in...

"Until one has loved an animal,

a part of one's soul remains unawakened."

~Anatole France~

...but the next morning we were on the road at 5 AM to see if she was still there. Again, it was hard to make her out, but there she was! We stayed with her for an hour, but except for those twitching ears, she didn't move. 

So, we went back that evening, and we were actually relieved to see that she had moved on...that she was OK...until we pulled off the road to turn around. That's when we found her. Dead, in a clearing, with two broken legs. How she managed to get out of the mud and through the underbrush to the clearing I will never understand. The pain. The suffering. We were stunned. Heartbroken. And so, so sad for her.

"May all that have life

be delivered from suffering."

~Buddha~

Why am I sharing this story on a narrative healing blog?

I can't get her off my mind. Perhaps telling her story will help me accept it. Maybe it will serve to caution inattentive or careless drivers. Maybe it will honor her suffering, in some way. 

It makes me wonder how I will bear my own  pain when the time comes. What if I go into heart failure? Or I develop cancer? Or I fall and I can't get up? Will I bear it quietly? Courageously? Patiently? How will I prepare my family for it? 

~Ilan Shamir~

As health care providers, we all witness pain and suffering. We are trained to do whatever we can to relieve it. We all witness death. In some cases, we have time to prepare our patients for it. We are sometimes called to break the news to their families. I held my mother's hand during her last hours, and stayed with her until she took her last breath. She didn't die alone, in pain, to be discovered too late by some passerby.

It makes me wonder how, in that vast wilderness, a solitary moose and a rare passing vehicle happened upon each other that day. Why? What are we meant to learn from this disasterous stroke of synchrony?

It reminds us that we don't always know when someone is suffering. Like the moose in the mud, they may not let it show. 

We are reminded to seek them out. To be patient with them. To be kind and gentle always.

To hold space for them in our hearts when there is nothing we can do to help.

I'm pretty sure the moose just became my spirit animal.

jan